title: Management of low back pain in general practice - is it of acceptable quality: an observational study among 25 general practices in South Tyrol (Italy).
abstract: BACKGROUND
  There are several guidelines dealing with the management of low back pain (LBP), but only few studies on the quality of care provided within General Practices as judged against those guidelines.The objective of this study is to analyse the management of LBP in Italian General Practice and compare it with guideline recommendations.
  
  
  METHODS
  In this observational study, all patients visiting their General Practitioners (GPs) for treatment of LBP within a 8-week period were monitored for at least four weeks with regard to symptoms and diagnostic and therapeutic interventions. Management of LBP was judged by pre-defined quality indicators based on guideline recommendations.
  
  
  RESULTS
  Twenty-five of 114 eligible GPs participated in the study, representing a total of 43,012 registered patients. Of the 475 patients complaining of LBP and monitored for four weeks, 55.8% were diagnosed as having acute lumbar pain, 13.5% chronic lumbar pain, 17.1% acute sciatica, and 12.6% chronic sciatica; 76.0% underwent no technical investigations, 21.7% underwent x-rays, 5.5% MRI and 4% CT scans; 20.4% were referred to secondary care; 93.3% of all patients received some medication. In those receiving a medication, in 88.3% it was an NSAID, in 6.3% Paracetamol, in 10.4% Paracetamol combined with Codeine, and in 9% a muscle relaxants. When physiotherapy was prescribed (17,1%), it was mostly massage. Hardly more than 50% of GPs (partially) followed locally established guidelines, while the remainder seemed not to follow guidelines at all.
  
  
  CONCLUSIONS
  Our study reveals gross deviations of GP management of LBP from current guidelines and points to two different types of deviators: those who partially follow guidelines, and those who do not follow them at all. Further research should evaluate whether these two types of deviation are best addressed by different foci of education, i.e. on knowledge versus attitudes, respectively.
authors.affiliation: Institute of General Practice, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany. jids@med.uni-duesseldorf.de.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Piccoliori
authors.forename: Adolf
authors.initials: A
authors.lastname: Engl
authors.forename: Doris
authors.initials: D
authors.lastname: Gatterer
authors.forename: Emiliano
authors.initials: E
authors.lastname: Sessa
authors.forename: Jürgen
authors.initials: J
authors.lastname: in der Schmitten
authors.forename: Heinz-Harald
authors.initials: HH
authors.lastname: Abholz
mesh_terms: D059787:Acute Pain / Q000175:diagnosis / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D059350:Chronic Pain / Q000175:diagnosis / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D058006:General Practice / Q000592:standards*; D019983:Guideline Adherence; D006801:Humans; D007558:Italy; D017116:Low Back Pain / Q000175:diagnosis* / Q000628:therapy; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008297:Male; D008405:Massage / Q000706:statistics & numerical data; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D017064:Process Assessment, Health Care; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012585:Sciatica / Q000175:diagnosis / Q000628:therapy; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D009465:Neuromuscular Agents